AIDS Healthcare Foundation

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Senior Director, Health Plan Operations

Senior Director, Health Plan Operations

Req No 
2018-8111
Job Locations 
US-FL-Fort Lauderdale
Category 
Managed Care
Type 
Regular Full-Time

More information about this job

WHO WE ARE

AIDS HEALTHCARE FOUNDATION
Does the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?

 

If so, AIDS Healthcare Foundation is the place for you!
Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the world.  Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay.  Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.

BENEFITS AT AHF
AHF offers comprehensive benefits to help our employees do and be their very best! These benefits are intended to enhance employee physical, financial, spiritual, and professional health.

 

Health Plans:

PHP (HMO SNP)
PHP is a Medicare Advantage Prescription Drug health plan specifically for Medicare beneficiaries who are living with HIV and reside in Duval, Broward and Miami-Dade Counties.
PHP is the first HIV-specific special needs health plan approved by the Centers for Medicare & Medicaid Services (CMS). This plan covers routine doctor and specialist office visits, emergency and urgent care, hospitalization, and more. It also includes a prescription drug benefit for no monthly premium.
 
PHC Florida
PHC Florida is a Medicaid managed care plan designed specifically for HIV-positive individuals who are eligible for Medicaid and live in Broward, Miami-Dade and Monroe Counties.  PHC Florida is a Managed Medical Assitance (MMA) plan offered through Florida’s statewide Medicaid Managed Care Program

YOUR CONTRIBUTION TO OUR SUCCESS!

The Senior Director, Health Plan Operations (SDHPO) is responsible for representing AHF’S Mission and Core Values to staff, stakeholders, collaborative agencies, vendors and governmental agencies.  The SDHPO carries out that responsibility by projecting and holding MC management staff accountable to the AHF Management Philosophy principles of 1) Mission Driven 2) Fairness 3) Learning 4) Hands On 5) Accountability and 6) Tenacity.

The SDHPO contributes to the Foundation’s success by managing and executing the strategic plan for managed care and the various managed care projects necessary to grow the Division and improve the efficiency and quality of care and services delivered.  The SDHPO must be independent, flexible and self-motivated individual who can develop a strategic analytical approach customized to meet the needs of any given situation as well as perform operational tasks when and where the situation requires.

The SDHPO functions as a leadership partner with the Chief of Managed Care and the Southern Bureau Chief.   The SDHPO directs, coordinates and supervises the Southern Bureau based managed care operations. This position requires significant capacity to manage multiple competing objectives, to prioritize, and to communicate complex information in clear and unambiguous terms to management, cross-functional team members and end user personnel.

 

This position ensures that the information, processes, execution tactics and key performance indicators for the particular Medicare, Medicaid, Ryan White contracts are disseminated and acted upon properly by the appropriate managers and staff in order to execute the contracts efficiently and effectively. The SDHPO is responsible for managing health plan risk and assuring compliance with local, state, federal laws, rules, regulations and guidance for external contractors such as CMS (Medicare Advantage), AHCA (Medicaid), Georgia Department of Community Health (GDCH),Network Providers and Ryan White (HRSA/EMA/TGA/State Funders).

 

This position requires significant professional knowledge and experience to manage multiple competing objectives, to prioritize, and to communicate complex information in clear and unambiguous terms to senior management, cross-functional team members and end user personnel, thereby improving organizational outcomes to meet the diverse needs of our members, providers and staff.

 

We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability. The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment.